Wound closure device including mesh barrier

ABSTRACT

A suturing device includes an elongate shaft defining a longitudinal axis, a trajectory guide translatably mounted on the elongate shaft and an introducer guard member operatively coupled to a distal portion of the elongate shaft. The introducer guard member includes at least one arm member which is movable between a first position in which the arm member is retracted, substantially in alignment with the longitudinal axis and a second position in which the at least one arm member is deployed. The introducer guard member includes an attaching member for releasably retaining a suture. The trajectory guide defines at least one bore therethrough. The bore obliquely extends through the trajectory guide and defines an angle with respect to the longitudinal axis. The bore aligns with the attaching member when the introducer guard member is in the second position.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to, and the benefit of, U.S.Provisional Patent Application No. 61/368,815, filed Jul. 29, 2010, theentire contents of which are hereby incorporated by reference.

BACKGROUND

1. Technical Field

The present disclosure relates to a wound closure device and, moreparticularly, to a wound closure device for suturing an opening intissue.

2. Background of Related Art

During endoscopic surgical procedures, for example, a trocar device isutilized to puncture the peritoneum to provide an access port by way ofa cannula through the abdominal wall. Generally, a trocar and/or cannulais placed through the abdominal wall for introduction of surgicalinstrumentation which is necessary to carry out the surgical procedure.In this manner, the surgeon may introduce a surgical instrument such asa grasper, scissor, clip applier, stapler or any other surgicalinstrument which may be necessary during the particular surgicalprocedure. Once the procedure is complete, it is necessary to close thewound.

Conventional instruments for closing puncture wounds generally include ashaft that can be extended into the body through either the puncturewound itself (in the case of a puncture caused by trauma) or through acannula (in the case of a puncture created to access a surgical site).Suture retaining needles are then deployed from the shaft into tissue.Unfortunately, the mechanisms used for deploying the needles are oftencumbersome and may make the extension and/or retraction of the suturingdevice difficult.

SUMMARY

In accordance with the present disclosure, a suturing device isprovided. The suturing device includes an elongate shaft defining alongitudinal axis, a trajectory guide mounted on the elongate shaft andan introducer guard member operatively coupled to the elongate shaft.The trajectory guide defines at least one bore therethrough. Theintroducer guard member includes at least one arm member that is movablebetween a first position in which the arm member is retracted,substantially in alignment with the longitudinal axis and a secondposition in which the at least one arm member is deployed, defining anangle with respect to the longitudinal axis.

In an embodiment, the arm member is hingedly connected to the elongateshaft. In particular, the arm member may be hingedly connected to adistal portion of the elongate shaft.

In another embodiment, the trajectory guide is translatable along theelongate shaft. The trajectory guide may include a locking mechanism forsecurely anchoring the trajectory guide to a position along the elongateshaft. The bore defined in the trajectory guide obliquely extendstherein with respect to the longitudinal axis.

In yet another embodiment, the arm member includes an attaching memberconfigured for releasably retaining a suture. The attaching member is ona first surface of the arm member. The bore is aligned with theattaching member when the arm member is in the second position.

In still another embodiment, the arm member includes an attaching memberconfigured for releasably retaining a suture. The attaching member isdisposed adjacent a distal end of the arm member. The bore is alignedwith the attaching member when the arm member is in the second position.

In still another embodiment, the suturing device further includes a meshdisposed on a second surface of the arm member when the arm member is inthe second position. The suture attaches the mesh against the secondsurface of the arm member when the arm member is in the second position.

In still another embodiment, the suturing device further includes acannulated needle defining a lumen therethrough. The bore of thetrajectory guide is dimensioned for receiving the cannulated needletherethrough. The suturing device may further include a rod. The lumenof the cannulated needle is configured for receiving the rodtherethrough. The rod may include catching structure for capturing thesuture releasably retained by the attaching member. The catchingstructure is disposed at a distal portion of the rod. The catchingstructure may be a hook.

In still another embodiment, the introducer guard member in the secondposition is substantially orthogonal with respect to the longitudinalaxis.

In still another embodiment, the trajectory guide is longitudinallytapered with respect to a width thereof.

In an alternative embodiment, the introducer guard member islongitudinally tapered with respect to a width thereof. Moreover, thearm member may be longitudinally tapered with respect to a widththereof.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the presently disclosed suturing instrument aredescribed herein with references to the accompanying drawings, wherein:

FIG. 1 is a side view of a suturing device in accordance with thepresent disclosure disposed in an opening in tissue;

FIG. 2 is a side view of the suturing device of FIG. 1 illustrating anintroducer guard member thereof in a deployed state;

FIG. 3 is a side view of the suturing device of FIG. 2 having a pair ofcannulated needles inserted through a trajectory guide of the suturingdevice;

FIG. 4 is a side view of the suturing device of FIG. 3 having a pair ofrods inserted through the pair of cannulated needles;

FIG. 4A is an enlarged view of the indicated area of detail of FIG. 4;

FIG. 4B is a side view of the suturing device of FIG. 1 illustrating amesh attached to the introducer guard member in a retracted state;

FIG. 4C is a perspective view of a two-piece mesh with parts separated;

FIG. 5 is a side view of the suturing device of FIG. 4 illustratingextraction of looped ends of a suture;

FIG. 6 is a side view of the suturing device of FIG. 5 illustratingextraction of the suturing device from an opening of tissue;

FIG. 7 is a cross-sectional view of tissue of FIG. 6 apposed by thesuture;

FIG. 8 is a side view of a ferrule assembly for use with the suturingdevice of FIG. 1; and

FIG. 9 is a side view of an actuation device for use with the suturingdevice of FIG. 1

DETAILED DESCRIPTION OF THE EMBODIMENTS

Various exemplary embodiments of the presently disclosed surgical devicewill now be described in detail with reference to the drawings whereinlike reference numerals identify similar or identical elements. In thedrawings and in the description which follows, the term “proximal” willrefer to the end of the component that is closer to the operator duringuse, while the term “distal” will refer to the end of the component thatis farther from the operator, as is traditional and conventional in theart.

With reference to FIGS. 1 and 2, a suturing instrument 100 generallyincludes an elongate shaft 110 defining a longitudinal axis “A-A,” atrajectory guide 120 translatably mounted on elongate shaft 110, and anintroducer guard member 130 operatively coupled to a distal end portion112 of elongate shaft 110. Trajectory guide 120 is translatably mountedon elongate shaft 110 and includes a locking mechanism (not shown) thatsecurely anchors trajectory guide 120 to a desired position alongelongate shaft 110. Thus, the distance between trajectory guide 120 andintroducer guard member 130 may be adjusted based on the anatomy of thepatient. Introducer guard member 130 includes a pair of arm members 132,134. As will be discussed in greater detail below, arm members 132, 134are movable from a first position in which arm member 132, 134 areretracted, substantially in alignment with longitudinal axis “A-A” asshown in FIG. 1 to a second position in which arm members 132, 134 aredeployed, defining a transverse axis “B-B” as shown in FIG. 2 or anacute angle with respect to the longitudinal axis “A-A,” for example.

With continued reference to FIGS. 1 and 2, trajectory guide 120 includesa generally tapered configuration to facilitate insertion/removalthereof into an opening in tissue “T.” Trajectory guide 120 definesbores 122, 124 (shown in phantom for illustrative purposes) that extendobliquely from a proximal end portion thereof to a distal end portionthereof, thereby forming an angle with respect to longitudinal axis“A-A.” Bores 122, 124 define longitudinal axes “D-D,” “E-E,”respectively. Bores 122, 124 may be dimensioned to receive one or moretypes of surgical instruments, e.g., surgical instruments configured tomanipulate a suture. The angle defined by each bore 122, 124 withrespect to longitudinal axis “A-A” may be tailored to meet the needs ofa particular procedure such that bores 122, 124 in conjunction withintroducer guard member 130 provide proper configuration for suture “S”to pierce through tissue “T,” as shown in FIG. 4. For example, a greaterdegree of angle needs to be selected if a wider mesh 148 is to bechosen, in order to ensure that mesh 148 tightly covers against theposterior side of the opening of tissue “T.” Moreover, by choosing agreater degree of angle, suture “S” enters the posterior side of tissue“T” away from the opening in tissue “T” which may inhibit tearing ofsutured tissue “T.” It is also envisioned that additional bores may bedefined in trajectory guide 120 to further accommodate other surgicalinstruments through trajectory guide 120.

With continued reference to FIGS. 1 and 2, introducer guard member 130is operatively connected to distal end portion 112 of elongate shaft110. In the illustrated embodiment, proximal end 136 of arm member 132is hingedly coupled to distal end portion 112 of elongate shaft 110 suchthat arm member 132 can be hingedly retracted, substantially inalignment with longitudinal axis “A-A” in order to facilitateinsertion/removal of introducer guard member 130 through the opening oftissue “T.” A proximal end of arm member 134 is substantially similarand is not shown. Hingedly coupled arm members 132, 134 can also bedeployed in the direction of arrows “X” shown in FIG. 1, such thatdeployed arm members 132, 134 define a transverse axis “B-B.” As shownin FIG. 2, deployed arm members 132, 134 are substantially orthogonal tolongitudinal axis “A-A.”

With reference now to FIGS. 3-5, there is illustrated introducer guardmember 130 including a pair of attaching members 144, 146 on a firstsurface 152 of arm members 132, 134, and more particularly, disposedadjacent free ends 140, 142 of arm members 132, 134, respectively.Attaching members 144, 146 may be in a form of prongs or pins configuredto releasably retain the ends of suture “S,” as shown in FIGS. 4 and 4A.Each end of suture “S” may, for example, form a loop so that suture “S”can be releasably anchored to each of attaching members 144, 146 asshown in FIGS. 4 and 4A. In the alternative, a slit dimensioned tosecure or wedge a portion of suture “S” to free ends 140, 142 of armmembers 132, 134 may be utilized such that when arm members 132, 134 aredeployed from the first position to the second position, suture “S” isnot dislodged or released from the slit. Additionally, introducer guardmember 130 includes a mesh 148 at least partially enclosing introducerguard member 130 when introduced into the opening in tissue “T,” asshown in FIG. 4B. Mesh 148 is connected to suture “S” which secures mesh148 to introducer guard member 130 by having each end of suture “S”anchored to each of attaching members 144, 146. Low tack adhesive may beused on mesh 148 to releasably hold surplus suture “S” on mesh 148 suchthat surplus suture “S” does not interfere with the procedure beingperformed. Alternatively, surplus suture “S” may be housed in a pocketdefined by a two-piece mesh 148 a welded on the edges, as shown in FIG.4C. Two-piece mesh 148 a includes an upper mesh portion 149 a and alower mesh portion 149 b. Upper mesh portion 149 a defines holes 153through which ends of suture “S” pass. Surplus suture “S” allows armmembers 132, 34 to move from the first position to the second positionwithout tearing suture “S” or mesh 148 a. As such, surplus suture “S”housed in the pocket does not interfere with the procedure beingperformed when arm members 132, 134 are in the first position.

As arm members 132, 134 are deployed in the opening in tissue “T,”surplus suture “S” is released from mesh 148 and mesh 148 becomesdisposed on a second surface 150 of introducer guard member 130 as shownin FIG. 4. Mesh 148 may be made of absorbable material and/or anysuitable bio-compatible material. Mesh 148 provides prophylaxis againstincisional hernia.

In the embodiment illustrated in FIGS. 3-5, a pair of cannulated needles160, 162 each defining a lumen therethrough are provided in bores 122,124 of trajectory guide 120. Cannulated needles 160, 162 are dimensionedto slidably extend through bores 122, 124 of trajectory guide 120,respectively. When introducer guard member 130 is in the secondposition, i.e., arm members 132, 134 are deployed, longitudinal axis“D-D,” “E-E” are in alignment with attaching members 144, 146,respectively. Cannulated needles 160, 162 are provided to extend throughbores 122, 124 and pierce through tissue “T” (e.g., a fascia of anabdominal cavity). Cannulated needles 160, 162 move through tissue “T”and further extend distally until reaching first surface 152 ofintroducer guard member 130. Attaching members 144, 146 that serve toreleasably anchor suture “S” also serve as a cannulated needle stopperto prevent cannulated needles 160, 162 from extending beyond free ends140, 142 of arm members 132, 134, respectively.

With particular reference to FIG. 4, a pair of rods 164, 166 each havingcatching structure coupled to a distal end portion thereof is provided.Catching structure may be, for example, a hook 170. However, othercatching structure may be employed. For example, a ferrule assembly 300,as shown in FIG. 8, may be disposed adjacent free ends 140, 142 of armmembers 132, 134, respectively. Ferrule assembly 300 is configured toreleasably retain a ferrule 360 which is adapted to retain a portion ofsuture “S.” A distal end of a needle 350 is configured to engage ferrule360 within ferrule assembly 300 for removal of ferrule 360 from ferruleassembly 300 along with suture “S”. Ferrule 360 frictionally engageswith open distal end of needle 350. However, it is further contemplatedthat needle 350 may also engage ferrule 360 through, for example,magnetic or adhesive, engagement.

Rods 164, 166 are dimensioned to slidably extend through lumens ofcannulated needles 160, 162. Rods 164, 166 that extend through lumens ofcannulated needles 160, 162 are directed towards attaching members 144,146 on first surface 152 of introducer guard member 130. By utilizinghooks 170 provided at the distal end portions of rods 164, 166, asurgeon may manipulate rods 164, 166 from a relatively remote locationto capture the looped ends of suture “S” anchored to attaching members144, 146. Subsequently, rods 164, 166, now engaging looped ends ofsuture “S,” may be pulled proximally and out of trajectory guide 120,thereby disengaging looped ends of suture “S” from attaching members144, 146 as shown FIG. 5. Consequently, the looped ends of suture “S”are pulled out of trajectory guide 120. Thereafter, looped ends ofsuture “S” are disengaged from rods 164, 166 such that cannulatedneedles 160, 162 may be withdrawn from trajectory guide 120. Uponextraction of rods 164, 166 and cannulated needles 160, 162 fromtrajectory guide 120, suturing instrument 100 is now ready to be removedfrom the opening in tissue “T” by first releasing the lock mechanism ontrajectory guide 120 and retracting arm members 132, 134 of introducerguard member 130 to the first position. Thereafter, suture “S” that isconnected to mesh 148 is ready to be tied to appose tissue “T,” as willbe discussed in greater detail below.

Operation of suturing device 100 will now be described with reference toFIGS. 1-7. In the description that follows, it is assumed that suturingdevice 100 is in the ready-to-use condition. Specifically, mesh 148 hasbeen secured to second surface 150 of arm members 132, 134 by suture “S”which is releasably anchored to attaching member 144, 146 of arm members132, 134, respectively (as best seen in FIG. 4).

Initially, with introducer guard member 130 in a retracted position,substantially in alignment with longitudinal axis “A-A” of elongateshaft 110, suturing device 100 is inserted into an opening in tissue “T”created by, e.g., trocar, obturator, or the like. A distal portion ofelongate shaft 110 is first inserted through the opening in tissue “T”and trajectory guide 120 is securely wedged into the opening in tissue“T.” The surgeon adjusts the distance between trajectory guide 120 andintroducer guard member 130 based on the anatomy of the patient bymoving trajectory guide 120 along elongate shaft 110. Once the desireddistance is achieved, the locking mechanism on trajectory guide 120 isutilized to securely anchor trajectory guide 120 to a desired positionalong elongate shaft 110. Alternatively, the surgeon may positiontrajectory guide 120 in the opening in tissue “T” and move elongateshaft 110 relative to trajectory guide 120 to adjust position ofintroducer guard member 130. Trajectory guide 120, as shown in FIG. 4B,may include additional set of bores 122 a, 124 a, each defininglongitudinal axis “K-K,” “L-L” in order to account for the change inangle when the distance between trajectory guide 120 and introducerguard member 130 is varied. It is contemplated that trajectory guide 120may further include a plurality of bores to further accommodate a widerange of patients and procedures being performed. Moreover, elongateshaft 110 may include indicia related to distance between trajectoryguide 120 and introducer guard member 130 indicating which bores to use.The tapered configuration of trajectory guide 120 facilitates secureanchoring thereof to the opening in tissue “T.” Upon anchoringtrajectory guide 120 to the opening in tissue “T,” aim members 132, 134of introducer guard member 130 that are hingedly coupled to distal endportion 112 of elongate shaft 110 are deployed in the direction of arrow“X” shown in FIG. 1 by an actuating mechanism. It is also contemplatedthat introducer guard member 130 coupled to elongate shaft 110 may alsoinclude other linkages such as cam paths, rotating elements, etc.

The actuating mechanism may include a pneumatic actuating mechanism or ahydraulic actuating mechanism. The pneumatic actuating mechanism may usepressurized gas, e.g., compressed air, carbon dioxide, or the like, todeploy arm members 132, 134 from the retracted position. On the otherhand, the hydraulic actuating mechanism may use liquid, e.g., sterilizedwater, saline, or the like, to trigger the mechanical motion ofdeploying arm members 132, 134. The pneumatic and hydraulic actuatingmechanisms may be portable or non-portable mechanisms.

Deployed arm members 132, 134 are now oriented in a manner substantiallyorthogonal to longitudinal axis “A-A,” thereby defining transverse axis“B-B.” At this point, longitudinal axes of bores “D-D,” “E-E” align withattaching members 144, 146 disposed adjacent free ends 140, 142 of armmembers 132, 134, respectively.

With reference to FIG. 3, cannulated needles 160, 162 each having lumenstherethrough are slidably inserted through bores 122, 124, respectively.Bores 122, 124 that define longitudinal axes “D-D,” “E-E,” respectively,guide cannulated needles 160, 162 through tissue “T” and towardrespective attaching members 144, 146. Cannulated needles 160, 162 areprevented from extending beyond free ends of arm member 140, 142 by therespective attaching members 144, 146. Upon reaching attaching member144, 146, cannulated needles 160, 162 come in contact with first surface152 of introducer guard member 130.

With reference to FIG. 4, upon placing cannulated needles 160, 162having lumens therethrough on first surface 152 of arm members 132, 134,rods 164, 166 are slidably inserted through the lumens of cannulatedneedles 160, 162, respectively. Rods 164, 166 exit cannulated needles160, 162, adjacent attaching member 144, 146 having looped ends ofsuture “S” anchored thereto. Catching structure such as hooks 170provided at distal end portions of rods 164, 166 are utilized to capturethe looped ends of suture “S” by manipulating rods 164, 166 from arelatively remote location. Looped ends of suture “S” releasablyanchored to attaching members 144, 146 are captured by hooks 170 anddisengage from attaching members 144, 146.

With reference to FIG. 5, the looped ends of suture “S” now disengagedfrom attaching members 144, 146 are proximally pulled through lumens ofcannulated needles 160, 162, respectively, until the ends of suture “S”have been withdrawn from bores 122, 124 adjacent proximal end portionsof trajectory guide 120. Following the extraction of the looped ends ofsuture “S,” cannulated needles 160, 162 and rods 164, 166 are removedfrom trajectory guide 120 such that suture “S” now directly piercesthrough tissue “T.” Upon removal of cannulated needles 160, 162 suturinginstrument 100 may be proximally pulled out of tissue “T” by firstplacing the arms 132, 134 in the retracted position and releasing thelocking mechanism on trajectory guide 120 to permit trajectory guide 120to be translatable along elongate shaft 110. Trajectory guide 120 nowtranslatable along elongate shaft 110 is proximally translated todisengage from the opening in tissue “T.” At the same time, elongateshaft 110 may be slightly pushed distally to provide sufficient spacefor arm members 132, 134 to retract to the initial position in whichintroducer guard member 130 is in substantial alignment withlongitudinal axis “A-A.” As shown in FIG. 6, trajectory guide 120 insubstantial alignment with longitudinal axis “A-A” is pulled out of theopening in tissue “T” by which the looped ends of suture “S” exit bores122, 124 from the distal end portions of trajectory guide 120. At thistime, suturing instrument 100 is withdrawn from the opening in tissue“T,” while leaving suture “S” containing mesh 148 and directly piercingtissue “T” in place.

After the removal of suturing instrument 100 from the opening of tissue“T,” suture “S” having mesh 148 remains in place with respect to tissue“T” and is now ready to be tied to appose tissue “T,” as will bediscussed in greater detail below. As discussed above, the degree ofangle of bores 122, 124 with respect to longitudinal axis “A-A” and thelength of arm members 132, 134 may be tailored to meet the suitableneeds of the procedure being performed. For example, a greater degree ofangle needs to be selected if a bigger mesh 148 is to be chosen, inorder to ensure that mesh 148 tightly covers against the posterior sideof the opening of tissue “T.” Moreover, by choosing a greater degree ofangle, suture “S” enters the posterior side of tissue “T” away from theopening in tissue “T” which may inhibit tearing of sutured tissue “T.”With reference to FIG. 7, the looped ends of suture “S” are now tiedtogether to appose tissue “T,” while providing mesh 148 to the secondsurface of tissue “T.”

It is contemplated that an actuator assembly 500 as shown in FIG. 9 maybe used with suturing device 100 of the present disclosure to actuatearm members 132, 134 from the first position to the second position orvice versa. Actuator assembly 500 includes a knob 540 and a baseassembly 560. Knob 540 and base assembly 560 are coupled by elongateshaft 110. Base 560 defines a bore 561 in which a biasing member 562 ishoused in longitudinal alignment with shaft 110. Aim members 532, 534are hingedly coupled to an engaging portion 536 of base 560 about pivots535 a, 535 b, respectively. Each arm member 532, 534 defines a slot 537for slidably accommodating therein pin 538 protruding transversely fromshaft 110 (only slot 537 defined in arm member 534 is shown in FIG. 9).As knob 540 is pressed distally by the operator, pin 538 of shaft 110translates distally with respect to engaging portion 536 of base 560,and slots 537 urge respective members 532, 534 to the retracted position(first position). At this time, arm members 532, 534 are longitudinallyaligned with shaft 110 and are ready to be inserted into the opening intissue “T.” It is further contemplated that a locking mechanism (notshown) may be provided to lock arm members 532, 534 in the firstposition. Upon releasing of knob 540 by the operator, biasing member 562moves shaft 110 proximally with respect to engaging portion 536 of base560 such that pin 538 translates proximally, which in turn urges armmembers 532, 534 to be deployed to the second position, as shown in FIG.9. Mesh 148 can also be attached to arm members 532, 534 by suture “S.”As discussed above, attaching members 144, 146 in a form of prongs orpins configured to releasably retain the ends of suture “S” may beprovided on arm members 532, 534.

From the foregoing and with reference to the various figure drawings,those skilled in the art will appreciate that certain modifications canalso be made to the present disclosure without departing from the scopeof the same. While several embodiments of the disclosure have been shownin the drawings, it is not intended that the disclosure be limitedthereto, as it is intended that the disclosure be as broad in scope asthe art will allow and that the specification be read likewise.Therefore, the above description should not be construed as limiting,but merely as exemplifications of particular embodiments. Those skilledin the art will envision other modifications within the scope and spiritof the claims appended hereto.

What is claimed is:
 1. A suturing device comprising: an elongate shaftdefining a longitudinal axis; a trajectory guide mounted on the elongateshaft, the trajectory guide defining first and second borestherethrough, the first and second bores each having a proximal end, atleast one of the first and second bores extending obliquely with respectto the longitudinal axis; and an introducer guard member operativelycoupled to the elongate shaft, the introducer guard member including atleast one arm member, the at least one arm member being movable betweena first position in which the at least one arm member is substantiallyin alignment with the longitudinal axis and a second position in whichthe at least one arm member is off-set with respect to the longitudinalaxis, wherein the trajectory guide is movable along the longitudinalaxis and independently of the introducer guard member, and the proximalends of the first and second bores diametrically oppose each other. 2.The suturing device of claim 1, wherein the at least one arm member ishingedly connected to the elongate shaft.
 3. The suturing device ofclaim 1, wherein the at least one arm member is hingedly connected to adistal portion of the elongate shaft.
 4. The suturing device of claim 1,wherein the trajectory guide includes a locking mechanism for securelyanchoring the trajectory guide to a position along the elongate shaft.5. The suturing device of claim 1, wherein the at least one arm memberincludes an attaching member configured for releasably retaining asuture.
 6. The suturing device of claim 5, wherein the attaching memberis on a first surface of the at least one arm member.
 7. The suturingdevice of claim 6, wherein one of the first and second bores is alignedwith the attaching member when the at least one arm member is in thesecond position.
 8. The suturing device of claim 6, further comprising amesh disposed on a second surface of the at least one arm member whenthe at least one arm member is in the second position.
 9. The suturingdevice of claim 8, wherein the suture attaches the mesh against thesecond surface of the at least one arm member when the at least one armmember is in the second position.
 10. The suturing device of claim 5,wherein the attaching member is disposed adjacent a distal end of the atleast one arm member.
 11. The suturing device of claim 10, wherein theat least one of the first and second bores is aligned with the attachingmember when the at least one arm member is in the second position. 12.The suturing device of claim 5, further comprising a cannulated needledefining a lumen therethrough, wherein one of the first and second boresof the trajectory guide is dimensioned for receiving the cannulatedneedle therethrough.
 13. The suturing device of claim 12, furthercomprising a rod, the lumen of the cannulated needle being configuredfor receiving the rod therethrough.
 14. The suturing device of claim 13,wherein the rod includes a catching structure for capturing the suturereleasably retained by the attaching member.
 15. The suturing device ofclaim 14, wherein the catching structure is disposed at a distal portionof the rod.
 16. The suturing device of claim 15, wherein the catchingstructure is a hook.
 17. The suturing device of claim 1, wherein theintroducer guard member in the second position is substantiallyorthogonal with respect to the longitudinal axis.
 18. The suturingdevice of claim 1, wherein the trajectory guide is longitudinallytapered with respect to a width thereof.
 19. The suturing device ofclaim 1, wherein the introducer guard member is longitudinally taperedwith respect to a width thereof.
 20. The suturing device of claim 1,wherein the at least one arm member is longitudinally tapered withrespect to a width thereof.
 21. The suturing device of claim 1, whereinthe trajectory guide surrounds a portion of the elongate shaft.
 22. Thesuturing device of claim 1, wherein one of the first and second boresextends between proximal and distal portions of the trajectory guide.